When it comes to tackling acne, it can sometimes be hard to know what treatments and strategies are going to help—and what’s going to irritate your skin and make the situation on your face worse. A prime example of this: facials. Some swear by them for making lesions fade faster; others insist you should steer clear to avoid more flares. What gives? Julie Harper, MD, immediate past president of the American Acne and Rosacea Society and an Acne Store advisory board member explains everything you need to know about different types of facials for acne.  

Q: Should patients with acne ever get a facial? 

A: I'm not against them, but they're not where you start when treating acne. A lot of the time, a patient will try a facial for their acne before they even see me—and that’s the wrong order. I do believe there's a role for an aesthetician, but they’re going to be a nice addition to a plan. I wouldn’t just book one without consulting a dermatologist first. 

 Q: How do you find a good aesthetician when you have acne? 

It’s crucial to find someone who really knows what they’re doing so they don’t over-manipulate the skin. That’s often a medical esthetician. In my practice, these aestheticians have their license and are also trained with me so he or she knows the way that I treat acne, rosacea, and eczema, and which of the different types of facials may complement a client’s skincare plan. You might be able to find a good one at a spa but using someone who works with your dermatologist would be the safest bet.

Q: Are extractions ever a good idea?

A: I recommend those in certain cases—say, for example, a patient has little white bumps under the skin and I’ve given them a topical retinoid for two or three months and those bumps are still there. Physical extraction by someone who is trained can be helpful in that case. 

Q: What is a medical facial?

A: A medical facial will be very similar to a regular facial, with cleansing, treating, massaging, and moisturizing, but with the addition of medical-grade products and procedures. In my office, our aesthetician is probably more hands-off than others may be. She’s got a lot of respect for what manipulating the skin can do—both the positives and the negatives. We don't want to do anything that makes acne more irritated or more red.  

Q: How should you prepare for a medical acne facial?

A: Tell the aesthetician what active ingredients you're using, especially if a topical retinoid is part of your regimen. Those products can make the surface of your skin a bit thinner [1] and may make it more likely you’ll be irritated by other products used in an acne facial. And if you’ve been asked to stop using any products before your facial, be sure to talk to your aesthetician about when it will be ok to start reusing your medicines. 

Q: Should you change your routine leading up to or after your acne facial? 

A: You should definitely adjust your use of topical retinoids, depending on what the aesthetician is going to be doing. If they're just doing extractions, for example, stay the course because retinoids can actually complement extractions—these products will actually help all that gunk come out more easily. But if you're coming in for a chemical peel, we recommend stopping your retinoid for about a week before and after the peel. Then you’ll restart again slowly—just a few times a week—and gradually get back up to daily use.

Q: Is it OK to put on makeup after a medical facial?

A: I would wait an hour or two at least. But you should definitely put on sunscreen, especially if you have fair skin. You might be a little red after, due in part to the good blood flow there, as massage has been shown to increase dilation of blood vessels in the area. But that usually fades in a day or two. [2] The night after your medical facial, use as little as possible so you don’t risk any irritation. A very gentle cleanser and sun protection the next day is enough.

Q: What about people who might be thinking, “Forget that—I can pop my own zit?”

A: This may surprise you a bit, but I actually think if you can gently drain a lesion on your own, particularly if it’s a big pus-filled one, I don't blame you one bit. I wouldn't want to go to school or work with that on my face either. But if popping a pimple is going to require anything more than gentle touch, you need to stop because you could very well do more damage than good. In these cases, see a dermatologist or medical aesthetician to start a skincare plan or schedule the best facial for your acne. 

References:

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791161/

[2]: https://linkinghub.elsevier.com/retrieve/pii/S0965229918306423